Senior Investigator

Clover Health

9d•$104,000 - $127,000•Remote

About The Position

The Special Investigation Unit (SIU) is a motivated, collaborative team sitting at the intersection of Compliance, Payment Integrity, and Data Infrastructure. The SIU ensures that Clover monitors, identifies and investigates instances of healthcare fraud, waste and abuse (FWA). Come join us as we discover new opportunities to enhance the fight against FWA! As the Senior Investigator, you will play a critical role ensuring that Clover is able to continue to build and scale a compliant, effective FWA audit program. You will work to ensure quality assurance standards and regulatory policy are reflected in our audit practices. You will be joining a fast-growing and fast-moving startup at the intersection of healthcare and technology, where you will have the opportunity to develop both your policy and operational skills. A successful Senior Investigator will have a robust FWA knowledge base and be able to develop, document and execute an effective and efficient FWA audit strategy to identify, audit, track, and report on known or suspected instances of FWA.

Requirements

You have 5+ years of experience in the healthcare FWA space.
You have experience identifying operations and process improvement efforts.
You have an understanding of compliance & payer requirements including Medicare regulations.
You have knowledge on fraud statutes and regulations

Nice To Haves

You have a Fraud Investigation Certification (CFE, AHFI, etc.) - preferred but not required.

Responsibilities

Lead development and execution of SIU process improvements to improve the effectiveness and efficiency of our SIU audit processes
Identify control opportunities to mitigate FWA
Identify possible audit opportunities
Implement an effective audit strategy to investigate known or suspected instances of FWA
Support annual FWA audit goals
Support complex provider conversations around FWA audit findings
Prepare response letters to deliver decisions to providers within the regulatory timeframes set forth by the Centers for Medicare & Medicaid Services (CMS).
Manage overall audit workload to ensure timely and accurate audit results
Act as a FWA subject matter expert
Mentor other team members on audit strategies
Build strong working relationships with both regulatory and law enforcement agencies, and
Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams.

Benefits

Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
Reimbursement for office setup expenses
Monthly cell phone & internet stipend
Remote-first culture, enabling collaboration with global teams
Paid parental leave for all new parents
And much more!